Provider Demographics
NPI:1932458783
Name:MOORE, SHELLEY L (RAS)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LANDING CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7901
Mailing Address - Country:US
Mailing Address - Phone:530-898-8326
Mailing Address - Fax:530-898-0239
Practice Address - Street 1:40 LANDING CIR STE 1
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7901
Practice Address - Country:US
Practice Address - Phone:530-898-8326
Practice Address - Fax:530-898-0239
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM0508301512101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)